Prehypertension

Last updated
Prehypertension
Other namesHigh normal blood pressure, borderline hypertensive (BH)
Specialty Cardiology

Prehypertension, also known as high normal blood pressure and borderline hypertensive (BH), [1] is a medical classification for cases where a person's blood pressure is elevated above optimal or normal, but not to the level considered hypertension (high blood pressure). Prehypertension is now referred to as "elevated blood pressure" by the American College of Cardiology (ACC) and the American Heart Association (AHA). [2] The ACC/AHA define elevated blood pressure as readings with a systolic pressure from 120 to 129  mm Hg and a diastolic pressure under 80 mm Hg, and the European Society of Cardiology and European Society of Hypertension (ESC/ESH) define "high normal blood pressure" as readings with a systolic pressure from 130 to 139 mm Hg and a diastolic pressure 85-89 mm Hg. [3] Readings greater than or equal to 130/80 mm Hg are considered hypertension by ACC/AHA and if greater than or equal to 140/90 mm Hg by ESC/ESH. [4]

Contents

Classification of blood pressure is based upon two or more readings at two or more separate occasions, and compared to out-of-office blood pressure readings if possible. [5] [6]

Signs and symptoms

Prehypertension is often asymptomatic (without symptoms) at the time of diagnosis. Only extremely elevated blood pressure (malignant hypertension) can, in rare cases, cause headaches, visual changes, fatigue, or dizziness, but these are nonspecific symptoms which can occur with many other conditions. Thus, blood pressures above normal can go undiagnosed for a long period of time.

Causes

Elevated blood pressure develops gradually over many years usually without a specific identifiable cause. However, possible medical causes, such as medications, kidney disease, adrenal problems or thyroid problems, must first be excluded. High blood pressure that develops over time without a specific cause is considered benign or essential hypertension. Blood pressure also tends to increase as a person ages.

Management

To lower the risk of prehypertension progressing to hypertension, modification of lifestyle or behaviors is necessary.

Lifestyle modifications

Diet

A low-sodium, high potassium diet is recommended, along with increasing physical activity to at least thirty minutes a day most days of the week, quitting smoking, reducing alcohol consumption, and maintaining a healthy weight. [7]

Specifically, a diet that is high in fruits and vegetables (aim for half of your meal including non-starchy vegetables, like leafy greens, beans, carrots, cucumbers, tomatoes, etc.), whole grains, low in refined grains (e.g., white breads and baked goods made from white flour), low in saturated fats ( e.g., fatty cuts of meat or fried foods) and low in sodium (homemade or minimally processed) have been demonstrated through randomized controlled studies to significantly lower blood pressure. These types of diet changes alone can lower blood pressure greater than any single drug therapy. The effects of both diet and sodium reduction work together, meaning the more you improve your diet to include less saturated fat and more fruits and vegetables OR lower your sodium intake significantly below what is typical in industrialized nations, like the United States, the greater the benefit will be seen. Similarly, the better the quality of diet, the more the results will be seen. Significant results have been seen in 30 days. [8]

Foods rich in potassium include banana, papaya, sweet potato, dark leafy greens, avocado, prune juice, tomato juice, oranges, milk, yogurt, dried beans such as navy, pinto and black beans, chickpeas, lentils, beef, pork, fish, nuts and seeds such as pistachio, almonds, pumpkin, flax and sunflower seeds. [9]

Exercise

Exercise including aerobic exercise, [10] [11]  isometric exercise, [10] [11]  dynamic resistance training, [10] [12]  Tai Chi, [11]  Qigong, [11]  and Yoga [11] [13]  can reduce blood pressure in prehypertensive individuals.

Sleep

Lack of sleep can increase blood pressure, and longer sleep cycles may reduce blood pressure in prehypertensive individuals. [14]

Stress

Stress reducing techniques can improve elevated blood pressure. [15]

Monitoring

Careful monitoring for signs of end-organ damage or progression to hypertension is an important part of the follow-up of patients with prehypertension. Any change in blood pressure classification should be confirmed on at least one subsequent visit.

The major indication for pharmacologic antihypertensive therapy is progression to hypertension. The threshold is lower in patients with diabetes, chronic kidney failure, or cardiovascular disease. [16] The target blood pressure for these conditions is currently less than 120/80 mm Hg.

Home monitoring

Home monitoring of blood pressure can be used to monitor and track prehypertensive patients. This can help to raise the awareness of the patient and his / her doctor if blood pressure levels rise to hypertensive levels. Home monitoring can help to avoid white coat hypertension which results in blood pressure levels being elevated due to the presence of a doctor or physician in a "white coat". Monitoring at home or work at regular times each day helps to diagnose a patient with prehypertension or hypertension.

The American Heart Association website [17] says, "You may have what's called 'white coat hypertension'; that means your blood pressure goes up when you're at the doctor's surgery. Monitoring at home will help you measure your true blood pressure and can provide your doctor with a log of blood pressure measurements over time. This is helpful in diagnosing and preventing potential health problems."

People using home blood pressure monitoring devices are increasingly also using blood pressure charting software. These charting methods provide print outs for the patient's physician and reminders to check blood pressure.

Medication

Patients with other health conditions and elevated blood pressure, especially those with diabetes, kidney disease or heart disease, may be advised to take blood pressure medication. [18]

Prognosis

The extent to which prehypertension constitutes a serious health concern remains controversial. [19] Several long-term studies have suggested no significant increase in all-cause mortality over long periods of time for individuals falling within the prehypertensive range. [20] [21] Many studies further indicate a J-shaped relationship between blood pressure and mortality, whereby both very high and very low levels are associated with notable increases in mortality. [22] On the other hand, the National Heart, Lung, and Blood Institute suggests that people with prehypertension are at a higher risk for developing hypertension, or high blood pressure, compared to people with normal blood pressure. [23]

A 2014 meta-analysis concluded that prehypertension increases the risk of stroke, and that even low-range prehypertension significantly increases stroke risk [24] and a 2019 meta-analysis found elevated blood pressure increases the risk of heart attack by 86% and stroke by 66%. [25]

Epidemiology

Data from the 1999 and 2000 National Health and Nutrition Examination Survey (NHANES III) estimated that the prevalence of prehypertension among adults in the United States was approximately 31 percent and decreased to 28 percent in the 2011–2012 National Health and Nutrition Examination Survey. [26] The prevalence was higher among men than women. [26]

Risk factors

A primary risk factor for prehypertension is being overweight. Other risk factors include a family history of hypertension, a sedentary lifestyle, eating high sodium foods, smoking, and excessive alcohol or caffeine intake. [27]

See also

Related Research Articles

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Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic plaque in the arteries of the heart. It is the most common of the cardiovascular diseases. Types include stable angina, unstable angina, and myocardial infarction. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and improve with rest. Shortness of breath may also occur and sometimes no symptoms are present. In many cases, the first sign is a heart attack. Other complications include heart failure or an abnormal heartbeat.

A transient ischemic attack (TIA), commonly known as a mini-stroke, is a minor stroke whose noticeable symptoms usually end in less than an hour. TIA causes the same symptoms associated with strokes, such as weakness or numbness on one side of the body, sudden dimming or loss of vision, difficulty speaking or understanding language, slurred speech, or confusion.

<span class="mw-page-title-main">Blood pressure</span> Pressure exerted by circulating blood upon the walls of arteries

Blood pressure (BP) is the pressure of circulating blood against the walls of blood vessels. Most of this pressure results from the heart pumping blood through the circulatory system. When used without qualification, the term "blood pressure" refers to the pressure in a brachial artery, where it is most commonly measured. Blood pressure is usually expressed in terms of the systolic pressure over diastolic pressure in the cardiac cycle. It is measured in millimeters of mercury (mmHg) above the surrounding atmospheric pressure, or in kilopascals (kPa).

<span class="mw-page-title-main">Hypertension</span> Long-term high blood pressure in the arteries

Hypertension, also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. It is, however, a major risk factor for stroke, coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia. Hypertension is a major cause of premature death worldwide.

<span class="mw-page-title-main">Heart failure</span> Failure of the heart to provide sufficient blood flow

Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms, caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, and leg swelling. The shortness of breath may occur with exertion or while lying down, and may wake people up during the night. Chest pain, including angina, is not usually caused by heart failure, but may occur if the heart failure was caused by a heart attack. The severity of the heart failure is mainly decided based on ejection fraction and also measured by the severity of symptoms. Other conditions that may have symptoms similar to heart failure include obesity, kidney failure, liver disease, anemia, and thyroid disease.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

Cardiovascular disease (CVD) is any disease involving the heart or blood vessels. CVDs constitute a class of diseases that includes: coronary artery diseases, stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, abnormal heart rhythms, congenital heart disease, valvular heart disease, carditis, aortic aneurysms, peripheral artery disease, thromboembolic disease, and venous thrombosis.

<span class="mw-page-title-main">Pulse pressure</span> Difference between systolic and diastolic blood pressure

Pulse pressure is the difference between systolic and diastolic blood pressure. It is measured in millimeters of mercury (mmHg). It represents the force that the heart generates each time it contracts. Healthy pulse pressure is around 40 mmHg. A pulse pressure that is consistently 60 mmHg or greater is likely to be associated with disease, and a pulse pressure of 50 mmHg or more increases the risk of cardiovascular disease. Pulse pressure is considered low if it is less than 25% of the systolic. A very low pulse pressure can be a symptom of disorders such as congestive heart failure.

Antihypertensives are a class of drugs that are used to treat hypertension. Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke, heart failure, kidney failure and myocardial infarction. Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21%, and can reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease. There are many classes of antihypertensives, which lower blood pressure by different means. Among the most important and most widely used medications are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists (ARBs), and beta blockers.

<span class="mw-page-title-main">Aortic regurgitation</span> Medical condition

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<span class="mw-page-title-main">Pulmonary hypertension</span> Increased blood pressure in lung arteries

Pulmonary hypertension is a condition of increased blood pressure in the arteries of the lungs. Symptoms include shortness of breath, fainting, tiredness, chest pain, swelling of the legs, and a fast heartbeat. The condition may make it difficult to exercise. Onset is typically gradual. According to the definition at the 6th World Symposium of Pulmonary Hypertension in 2018, a patient is deemed to have pulmonary hypertension if the pulmonary mean arterial pressure is greater than 20mmHg at rest, revised down from a purely arbitrary 25mmHg, and pulmonary vascular resistance (PVR) greater than 3 Wood units.

Essential hypertension is the form of hypertension that by definition has no identifiable secondary cause. It is the most common type affecting 85% of those with high blood pressure. The remaining 15% is accounted for by various causes of secondary hypertension. Primary hypertension tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors. Prevalence of essential hypertension increases with age, and individuals with relatively high blood pressure at younger ages are at increased risk for the subsequent development of hypertension. Hypertension can increase the risk of cerebral, cardiac, and renal events.

<span class="mw-page-title-main">Hypertensive emergency</span> Profoundly elevated blood pressure resulting in symptomatic end-organ injury

A hypertensive emergency is very high blood pressure with potentially life-threatening symptoms and signs of acute damage to one or more organ systems. It is different from a hypertensive urgency by this additional evidence for impending irreversible hypertension-mediated organ damage (HMOD). Blood pressure is often above 200/120 mmHg, however there are no universally accepted cutoff values. Signs of organ damage are discussed below.

<span class="mw-page-title-main">Hypertensive heart disease</span> Medical condition

Hypertensive heart disease includes a number of complications of high blood pressure that affect the heart. While there are several definitions of hypertensive heart disease in the medical literature, the term is most widely used in the context of the International Classification of Diseases (ICD) coding categories. The definition includes heart failure and other cardiac complications of hypertension when a causal relationship between the heart disease and hypertension is stated or implied on the death certificate. In 2013 hypertensive heart disease resulted in 1.07 million deaths as compared with 630,000 deaths in 1990.

<span class="mw-page-title-main">Nebivolol</span> Chemical compound

Nebivolol is a beta blocker used to treat high blood pressure and heart failure. As with other β-blockers, it is generally a less preferred treatment for high blood pressure. It may be used by itself or with other blood pressure medication. It is taken by mouth.

The DASH diet is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute to prevent and control hypertension. The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods. It includes meat, fish, poultry, nuts, and beans, and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public. DASH is recommended by the United States Department of Agriculture (USDA) as a healthy eating plan. The DASH diet is one of three healthy diets recommended in the 2015–2020 US Dietary Guidelines, which also include the Mediterranean diet and a vegetarian diet. The American Heart Association (AHA) considers the DASH diet "specific and well-documented across age, sex and ethnically diverse groups."

In medicine, systolic hypertension is defined as an elevated systolic blood pressure (SBP). If the systolic blood pressure is elevated (>140) with a normal (<90) diastolic blood pressure (DBP), it is called isolated systolic hypertension. Eighty percent of people with systolic hypertension are over the age of 65 years old.

<span class="mw-page-title-main">Heart failure with preserved ejection fraction</span> Medical condition

Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the left ventricle is maximally filled – is normal, defined as greater than 50%; this may be measured by echocardiography or cardiac catheterization. Approximately half of people with heart failure have preserved ejection fraction, while the other half have a reduction in ejection fraction, called heart failure with reduced ejection fraction (HFrEF).

Hypertension is managed using lifestyle modification and antihypertensive medications. Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. According to one 2003 review, reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34% and of ischaemic heart disease by 21% and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.

The Systolic Blood Pressure Intervention Trial (SPRINT) is a multi-center clinical trial that was performed from 2010 to 2015, and published in November 2015.

A non-pharmaceutical intervention or non-pharmacological intervention (NPI) is any type of health intervention which is not primarily based on medication. Some examples include exercise, sleep improvement, or dietary habits.

References

  1. ↑ Logan, Carolynn M.; Rice, M. Katherine (1987). Logan's Medical and Scientific Abbreviations. J. B. Lippincott and Company. p. 58. ISBN   0-397-54589-4.
  2. ↑ Whelton, Paul K.; Carey, Robert M.; Aronow, Wilbert S.; Casey, Donald E.; Collins, Karen J.; Dennison Himmelfarb, Cheryl; DePalma, Sondra M.; Gidding, Samuel; Jamerson, Kenneth A.; Jones, Daniel W.; MacLaughlin, Eric J.; Muntner, Paul; Ovbiagele, Bruce; Smith, Sidney C.; Spencer, Crystal C. (June 2018). "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Hypertension. 71 (6): 1269–1324. doi: 10.1161/HYP.0000000000000066 . ISSN   1524-4563. PMID   29133354. S2CID   207581793.
  3. ↑ Bakris, George; Ali, Waleed; Parati, Gianfranco (2019-06-18). "ACC/AHA Versus ESC/ESH on Hypertension Guidelines: JACC Guideline Comparison". Journal of the American College of Cardiology. 73 (23): 3018–3026. doi:10.1016/j.jacc.2019.03.507. ISSN   1558-3597. PMID   31196460. S2CID   189814197.
  4. ↑ Whelton, Paul K.; Carey, Robert M.; Mancia, Giuseppe; Kreutz, Reinhold; Bundy, Joshua D.; Williams, Bryan (2022-09-13). "Harmonization of the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension Blood Pressure/Hypertension Guidelines: Comparisons, Reflections, and Recommendations". Circulation. 146 (11): 868–877. doi: 10.1161/CIRCULATIONAHA.121.054602 . ISSN   1524-4539. PMID   35950927. S2CID   251494382.
  5. ↑ Whelton, Paul K.; Carey, Robert M.; Aronow, Wilbert S.; Casey, Donald E.; Collins, Karen J.; Dennison Himmelfarb, Cheryl; DePalma, Sondra M.; Gidding, Samuel; Jamerson, Kenneth A.; Jones, Daniel W.; MacLaughlin, Eric J.; Muntner, Paul; Ovbiagele, Bruce; Smith, Sidney C.; Spencer, Crystal C. (June 2018). "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". Hypertension. 71 (6): e13–e115. doi: 10.1161/HYP.0000000000000065 . ISSN   1524-4563. PMID   29133356. S2CID   34986818.
  6. ↑ Williams, Bryan; Mancia, Giuseppe; Spiering, Wilko; Agabiti Rosei, Enrico; Azizi, Michel; Burnier, Michel; Clement, Denis L.; Coca, Antonio; de Simone, Giovanni; Dominiczak, Anna; Kahan, Thomas; Mahfoud, Felix; Redon, Josep; Ruilope, Luis; Zanchetti, Alberto (2018-09-01). "2018 ESC/ESH Guidelines for the management of arterial hypertension". European Heart Journal. 39 (33): 3021–3104. doi: 10.1093/eurheartj/ehy339 . ISSN   1522-9645. PMID   30165516.
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  9. ↑ "Functions and Food Sources of Common Minerals". Dietitians of Canada. 2011-11-03. Archived from the original on 2017-01-18. Retrieved 2017-07-02.
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  11. 1 2 3 4 5 Fu, Jinming; Liu, Yupeng; Zhang, Lei; Zhou, Lu; Li, Dapeng; Quan, Hude; Zhu, Lin; Hu, Fulan; Li, Xia; Meng, Shuhan; Yan, Ran; Zhao, Suhua; Onwuka, Justina Ucheojor; Yang, Baofeng; Sun, Dianjun (2020-09-25). "Nonpharmacologic Interventions for Reducing Blood Pressure in Adults With Prehypertension to Established Hypertension". Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 9 (19): e016804. doi:10.1161/JAHA.120.016804. ISSN   2047-9980. PMC   7792371 . PMID   32975166.
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  13. ↑ Khandekar, Janhavi Sandeep; Vasavi, Vanamala Lakshmi; Singh, Vijay Pratap; Samuel, Stephen Rajan; Sudhan, S. G.; Khandelwal, Bidita (2021-09-13). "Effect of Yoga on Blood Pressure in Prehypertension: A Systematic Review and Meta-Analysis". The Scientific World Journal. 2021: 4039364. doi: 10.1155/2021/4039364 . ISSN   2356-6140. PMC   8452415 . PMID   34552393.
  14. ↑ Makarem, Nour; Shechter, Ari; Carnethon, Mercedes R.; Mullington, Janet M.; Hall, Martica H.; Abdalla, Marwah (2019-04-05). "Sleep Duration and Blood Pressure: Recent Advances and Future Directions". Current Hypertension Reports. 21 (5): 33. doi:10.1007/s11906-019-0938-7. ISSN   1534-3111. PMC   10239254 . PMID   30953237. S2CID   96450039.
  15. ↑ Geiger, Christoph; Cramer, Holger; Dobos, Gustav; Kohl-Heckl, Wiebke Kathrin (2022-10-10). "A systematic review and meta-analysis of mindfulness-based stress reduction for arterial hypertension". Journal of Human Hypertension. 37 (3): 161–169. doi:10.1038/s41371-022-00764-z. ISSN   1476-5527. PMID   36216879. S2CID   252816575.
  16. ↑ Sipahi I, Tuzcu EM, Schoenhagen P, et al. (August 2006). "Effects of normal, pre-hypertensive, and hypertensive blood pressure levels on progression of coronary atherosclerosis". J. Am. Coll. Cardiol. 48 (4): 833–8. doi: 10.1016/j.jacc.2006.05.045 . PMID   16904557.
  17. ↑ American Heart Association website
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  20. ↑ Taylor, BC; Wilt, TJ; Welch, HG (2011). "Impact of diastolic and systolic blood pressure on mortality: Implications for the definition of "normal"". Journal of General Internal Medicine. 26 (7): 685–90. doi:10.1007/s11606-011-1660-6. PMC   3138604 . PMID   21404131.
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  23. ↑ National Heart, Lung and Blood Institute< "What Are High Blood Pressure and Prehypertension?". Archived from the original on 2011-10-31. Retrieved 2011-11-04.>
  24. ↑ Huang, Y; Cai X; Li Y; Su L; Mai W; Wang S; Hu Y; Wu Y; Xu D. (Mar 12, 2014). "Prehypertension and the risk of stroke: A meta-analysis". Neurology. 82 (13): 1153–61. doi:10.1212/WNL.0000000000000268. PMID   24623843. S2CID   2414005.
  25. ↑ Han, Minghui; Li, Quanman; Liu, Leilei; Zhang, Dongdong; Ren, Yongcheng; Zhao, Yang; Liu, Dechen; Liu, Feiyan; Chen, Xu; Cheng, Cheng; Guo, Chunmei; Zhou, Qionggui; Tian, Gang; Qie, Ranran; Huang, Shengbing (December 2019). "Prehypertension and risk of cardiovascular diseases: a meta-analysis of 47 cohort studies". Journal of Hypertension. 37 (12): 2325–2332. doi:10.1097/HJH.0000000000002191. ISSN   1473-5598. PMID   31335511. S2CID   198191212.
  26. 1 2 Booth, John N.; Li, Jiexiang; Zhang, Lu; Chen, Liwei; Muntner, Paul; Egan, Brent (August 2017). "Trends in Prehypertension and Hypertension Risk Factors in US Adults: 1999-2012". Hypertension. 70 (2): 275–284. doi:10.1161/HYPERTENSIONAHA.116.09004. ISSN   1524-4563. PMC   5594566 . PMID   28607131.
  27. ↑ "Know Your Risk for High Blood Pressure". Centers for Disease Control and Prevention. 2020.
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